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European guideline and expert statements on the management of narcolepsy in adults and children
Author(s) -
Bassetti Claudio L. A.,
Kallweit Ulf,
Vignatelli Luca,
Plazzi Giuseppe,
Lecendreux Michel,
Baldin Elisa,
DolencGroselj Leja,
Jennum Poul,
Khatami Ramin,
Manconi Mauro,
Mayer Geert,
Partinen Markku,
Pollmächer Thomas,
Reading Paul,
Santamaria Joan,
Sonka Karel,
Dauvilliers Yves,
Lammers Gert J.
Publication year - 2021
Publication title -
journal of sleep research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.297
H-Index - 117
eISSN - 1365-2869
pISSN - 0962-1105
DOI - 10.1111/jsr.13387
Subject(s) - narcolepsy , modafinil , cataplexy , methylphenidate , guideline , excessive daytime sleepiness , psychiatry , psychology , pediatrics , medicine , attention deficit hyperactivity disorder , sleep disorder , insomnia , pathology
Summary Background and purpose Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence‐based guidelines for the management of narcolepsy in both adults and children. Methods The European Academy of Neurology (EAN), European Sleep Research Society (ESRS), and European Narcolepsy Network (EU‐NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach. Results A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness (EDS) in adults–scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong); methylphenidate, amphetamine derivatives (both weak); (ii) cataplexy in adults–SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) EDS in children–scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivatives (all weak); (iv) cataplexy in children–SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions. Conclusion The management of narcolepsy involves non‐pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.